Healthcare Provider Details

I. General information

NPI: 1063085330
Provider Name (Legal Business Name): SHARON SHAN HO PTA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/23/2021
Last Update Date: 07/23/2021
Certification Date: 06/25/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

215 N STATE COLLEGE BLVD STE G
ANAHEIM CA
92806-2932
US

IV. Provider business mailing address

12381 CLINTON ST
EL MONTE CA
91732-3960
US

V. Phone/Fax

Practice location:
  • Phone: 714-999-6596
  • Fax:
Mailing address:
  • Phone: 626-589-7331
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225200000X
TaxonomyPhysical Therapy Assistant
License Number51051
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: